Homestead_Montgomery�
� "'^ CLAIM FOR HOMESTEAD PROPERTY TAX
� STANDARD / SUPPLEMENTAL DEDUCTION
� State Porm Sd73 (R72 / 609)
,S 1 Presaibed by t�e Departmeni of Laal Govemmenl Friance
INB7RIICTIl1NS.Cwa mvame cidc Inrfili.v� �nemvnn��
FI ��
APR 2 6 2010
YEAR
� M/e) • v�0{¢�d as my (our) prindpal
place of residence or am (are) buying the following de �hed real property for which a Homes roperty x ndarcl Deduction is hereby daimed
under nVact on the date this application is filetl, (date o(filing):
I(We) avn ❑ Am (are) buying under recorded mnVact
❑ Am (are) enliUed to occupy as a tenant-stockhotder of a cooperative housing corporation
� Have a benefida� interest in ihe Wst or the right [o occupy ihe pmperry under Ne terms of a quali(ed personal residence Wst
•• � •
Nam daimant al name)
Sodal of daarent (bst fi�s d'gAS) Drivers frense / Itlenti:ration /
N ame)
$ocial Sea�
\til�c��
. .•� . /
tt buying om m�vact, Fee Simple ownefs �me
Reoordefs offire where mntraa is remrGed Remrd number Page
..�. . � . �
�nry Twmshiqy ' Tadn9 tlisUict (ciry, town. townshipl
rr�
/ �y¢) rcel nu hef�( (�/� /�� Q L d� ptian Is Ne pmpeM �n questim:
V� 1�'� ��J W� WI• � Y � P I ❑ Real ProPertY ❑ AnnuaOy assesseU modle home (IC bt. f-71
�It any portion ol ihe resden�al sWCNre or the WM not exceeding rne (1) aue Nat immeCiately surtaunds that swcWra is used to piodure incane, desmbe lhe use and portion
of Ne property utif¢eC b produre inmme.
P� ,�,� �3-3-�a �s.4s
_.. . .: . .
Counry Township Counry _ Towrtsttip
I hereby certify the above sfatements are we, cortect and complete. Sig r aai �
r
dress (wmber aM streef, ury, state, antl LP code)
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Land not exceeding 1 (one) acre immediatety �-<�'s: �� �`i'�--�� � � =�� �_:5
surrountlin resldentialim rovements. ��) >.��'� 4Ki����s�. '^s�'�.�.".-x,E.�
~ ���MY���•�':
Other land (2) +f'��-;h�°.��?s,.-�.?'
Tofal land (line f plus line 3) (3)
'? �. n Xk�j2' r Sf t'-R:'
Resldentlal improvements orMnualty �elling (4) ,y ',R ��+�r�r�3},�,'-'�. ?E't,efR
Assessed Mobile I Manufactured Home �� r��'� `�`y'� '�'�' k��;; ��",n `
Garage (5) R'�. ,>t��r��.cw"�sr;k�i,.Y�ZZ.w
Othetimprovements (6) tx""'�+ k��f'�
de r^id;
ToUI improvementt (line 4 NiougA line bj (7)
ro�ai �ai�a (line7 pha tlne � (e)
I hereby certify the above is [rue, correct, Sigr�awre af Assessor Da;e signed (monM, tlay, yea�
and complete.
Veifying adion - SignaNre of PLdibr Date signetl (rtronN, Oay, yea�
� � . - � � � • �
20 _ pay 20 Lesser of 60% of Ne assessed value of ihe homestead or $45,000
NMvithalerNing any oNer pmvisbn, the sum W Me detluctions pro�nded in IC 67.7-72 w a mo6tie Mme Nat is g
mt assessed as mal property or ro e manufeauied hwne Net is not assessed as rcal propeAy may rrot ezceed -
one-haH (72) olMe assessed velve o1 Me mob0e �ome wrt�nufdCUred home.
Signawre of PLOitor Date signed (monfh, day, yea�